Active NPI
Tracy Bertil
- Behavior Technician
- Riverview, FL
National Provider Identifier
1225579204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 103K00000X
- Practice address
- 11228 Creek Haven Dr
Riverview, FL 33569-6201 - Phone
- (516) 642-3871
- NPI assigned
- Mar 10, 2017
- Last updated
- Mar 10, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 103K00000X | FL | Primary |
Addresses
Primary practice location
11228 Creek Haven Dr
Riverview, FL 33569-6201
Mailing address
11228 Creek Haven Dr
Riverview, FL 33569-6201
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103K00000X | FL | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489104000000",
"number": "1225579204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11228 CREEK HAVEN DR",
"city": "RIVERVIEW",
"state": "FL",
"postal_code": "335696201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11228 CREEK HAVEN DR",
"city": "RIVERVIEW",
"state": "FL",
"postal_code": "335696201",
"telephone_number": "516-642-3871"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTIL",
"first_name": "TRACY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-10",
"last_updated": "2017-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "103K00000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverview, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.